Peer-reviewedCC BY-NC-NDPlastic and reconstructive surgery. Global open27 Oct 2026

Soft-tissue Coverage for Complex Knee Defects: The Role of Microsurgery in Optimizing Functional Limb Salvage.

Elena Galvano¹
Grant M Kleiber¹
Rajiv P Parikh^1,2

¹From the Department of Plastic Surgery, MedStar Health, MedStar Health Washington Hospital Center, Washington, DC.
²Section of Plastic Surgery, University of Michigan, Ann Arbor, MI.

Abstract

Background

Soft-tissue defects of the knee pose unique reconstructive challenges, and inadequate coverage can have devastating sequelae, including amputation. The purpose of this study is to evaluate the indications and role of microsurgical free flaps, in comparison with pedicled gastrocnemius flaps, for soft-tissue reconstruction of the knee.Methods

Patients undergoing soft-tissue reconstruction of knee defects from 2018 to 2024 at a tertiary care center were analyzed. Patient characteristics and outcomes were compared for reconstructions using free flaps versus gastrocnemius flaps. The primary outcome was limb salvage with ambulation. Secondary outcomes included patient-reported outcomes and complications.Results

A total of 43 patients comprised the study population: 25 with pedicled gastrocnemius flap and 18 with free flap reconstructions. Limb salvage was achieved in 88.9% of patients with free flaps and 84.0% of patients with pedicled flaps (P = 0.67). Functional outcomes were similar between free and pedicled flaps (mean Lower Extremity Functional Scale scores of 51.2 ± 13.6 versus 47.5 ± 12.8, P = 0.40). Defect size was larger in the microsurgical versus pedicled cohort (88 ± 35 versus 65 ± 20 cm², P = 0.019). Reoperations/secondary procedures were high in both cohorts: 55.6% of patients with free flaps versus 60.0% of patients with pedicled flaps (P = 0.62).Conclusions

Although pedicled flaps remain a mainstay of treatment algorithms, microsurgical reconstruction offers a safe and versatile option for achieving functional limb salvage in select large, complex knee defects. We advocate for a patient-centered and defect-specific approach to soft-tissue reconstruction of the knee.

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Cite

BibTeX RIS

BibTeX

@article{galvano2026softtissue,
  title = {{Soft-tissue Coverage for Complex Knee Defects: The Role of Microsurgery in Optimizing Functional Limb Salvage.}},
  author = {Elena Galvano and Grant M Kleiber and Rajiv P Parikh},
  journal = {Plastic and reconstructive surgery. Global open},
  year = {2026},
  month = oct,
  doi = {10.1097/gox.0000000000008214},
  url = {https://europepmc.org/article/MED/42948839},
  note = {CC BY-NC-ND},
}

RIS

TY  - JOUR
TI  - Soft-tissue Coverage for Complex Knee Defects: The Role of Microsurgery in Optimizing Functional Limb Salvage.
AU  - Elena Galvano
AU  - Grant M Kleiber
AU  - Rajiv P Parikh
PY  - 2026
DA  - 2026/10/27
JO  - Plastic and reconstructive surgery. Global open
DO  - 10.1097/gox.0000000000008214
UR  - https://europepmc.org/article/MED/42948839
AB  - Background  Soft-tissue defects of the knee pose unique reconstructive challenges, and inadequate coverage can have devastating sequelae, including amputation. The purpose of this study is to evaluate the indications and role of microsurgical free flaps, in comparison with pedicled gastrocnemius flaps, for soft-tissue reconstruction of the knee.Methods  Patients undergoing soft-tissue reconstruction of knee defects from 2018 to 2024 at a tertiary care center were analyzed. Patient characteristics and outcomes were compared for reconstructions using free flaps versus gastrocnemius flaps. The primary outcome was limb salvage with ambulation. Secondary outcomes included patient-reported outcomes and complications.Results  A total of 43 patients comprised the study population: 25 with pedicled gastrocnemius flap and 18 with free flap reconstructions. Limb salvage was achieved in 88.9% of patients with free flaps and 84.0% of patients with pedicled flaps (P = 0.67). Functional outcomes were similar between free and pedicled flaps (mean Lower Extremity Functional Scale scores of 51.2 ± 13.6 versus 47.5 ± 12.8, P = 0.40). Defect size was larger in the microsurgical versus pedicled cohort (88 ± 35 versus 65 ± 20 cm², P = 0.019). Reoperations/secondary procedures were high in both cohorts: 55.6% of patients with free flaps versus 60.0% of patients with pedicled flaps (P = 0.62).Conclusions  Although pedicled flaps remain a mainstay of treatment algorithms, microsurgical reconstruction offers a safe and versatile option for achieving functional limb salvage in select large, complex knee defects. We advocate for a patient-centered and defect-specific approach to soft-tissue reconstruction of the knee.
SN  - 2169-7574
ER  -

Abstract

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